Sunday, March 20, 2011

Time to revisit LHSC panel discussion on state of Canadian health care

When just a little girl, my daughter asked her mother, "Mom, what's a bum-ticker?" She had heard that Crusty the Clown on the Simpsons might be dropped from the show because of his "bum-ticker." She placed the accent on "bum."

As a man with a "bum-ticker" who is still alive today thanks to the Canadian health care system, I give our system a thumbs up. But it doesn't get two thumbs up, or rate a ten, or top out in whatever scale of measurement you use. One must admit, our system has problems.

Dr. Nick Kates speaking at the LHSC discussion.
It was almost exactly a year ago that a blue-ribbon panel of doctors was assembled for an interactive panel discussion at University Hospital in London, Ontario. The panel, sponsored by the student Medical Reform Group at the Schulich School of Medicine & Dentistry at the University of Western Ontario was composed of: Dr. Jeff Turnbull , president-elect of the Canadian Medical Association; Dr. Robert McMurtry, former special advisor to the Canadian Royal Commission on the Future of Health Care in Canada; Dr. Nick Kates, Ontario lead for the Quality Improvement and Innovation Partnership, and Dr. Debby Copes, the quality advisor for the Choice in Health Clinic in Toronto.

Dr. Robert McMurtry, the dean of the Faculty of Medicine and Dentistry at the University of Western Ontario from 1992 to 1999, set the tone of the evening as he explained why he believes in the Canadian health caresystem.

He told the story of two lawyers: one his father and the other his brother, the late Bill McMurtry, a tireless crusader for social justice and author of the 1974 McMurtry Report on Violence in Hockey.

His father, Roy McMurtry senior, had had rheumatic heart disease and was unable to buy medical insurance. When his father suffered a stroke in the early '50s, in the days before medicare, McMurtry senior was left financially crippled by the mounting medial expenses.

Years later, when his brother Bill was diagnosed with stage 4 lung cancer, Bill considered leaving Canada for treatment. He searched broadly outside the country but discovered the care being "offered in Toronto was as good as it gets."

Robert McMurtry and the other three panelists all firmly believe in publicly funded health care. Yet there is increasing pressure in Canada to expand the role of the private-sector in health care, he said.

Dr. Jeff Turnbull
According to Dr. Jeff Turnbull, chief of staff, Ottawa Hospital, when it comes to health care in Canada there is "an elephant in the room", and that elephant is cost. He said health care costs make up more than 40 percent of the Ontario government’s total program spending and could hit 50 percent.

McMurtry added that although these percentages do not tell the whole story they do grab headlines. Reporters love these numbers.

The answer is not more private-sector involvement, according to Dr. Debby Copes who cited a McMaster University study: "There's a lot of evidence that shows private for-profit health care costs more and has poorer outcomes (compared to publicly funded systems)." There was a great deal of support for Copes' position on the panel.

Whether the approach is public or private, both must face the same problems — such as an aging population. According to Kates, "The problems are there, and will be there, no matter what."

With a public system, "We are all in the same lifeboat. There is more incentive to make it work."

On the positive side, there are many examples of the public system learning to do what McMurtry was suggesting — "innovate or perish." We not only have to do better than we are doing now, we can do better.

An example of what McMurtry was suggesting is the trauma, emergency and critical care (TECC) program at Sunnybrook Health Sciences Centre in north-central Toronto. The centre is well know for its dedication to innovative, quality care.

Or look to the activity-based funding being championed by Alberta Health Services. "They found they could do it faster, cheaper and better. That should be our model." There is so much we could do better than we do now, McMurty continued.

This was a theme that ran through the presentations of all the panelists. Canadians must get more bang for the their health care buck. We must use our existing resources more efficiently.

All agreed it won’t be easy for the Canadian health system to regain its social justice mojo which was front and centre at its birth those many decades ago. Over the passing years a fiscal agenda has pushed aside the service agenda.

The panel took an aggressive stance when it came to change. "We have to think differently, better, smarter," according to Turnbull. He went on to show how "it can be done." He spoke proudly of Ottawa Inner City Health Inc., rattled off a long list of programs offered, and then added the kicker: "It saves $3.5 million annually."

Wrapping up the night, Kates made it clear the health care system must embrace change but within a social justice framework. He said: " 'Insanity: doing the same thing over and over again and expecting different results.' Albert Einstein."

Dr. Debby Copes
Copes smiled and added: " 'Without deviation from the norm, progress is not possible': Frank Zappa."

After the panel discussion, Dr. Jeff Turnbull, chief of staff Ottawa Hospital, I asked about the furor over the Premier of Newfoundland, Danny Williams, travelling to Florida for heart surgery.

Turnbull was not going to be drawn into commenting but he did say, on the record, there is no long queue of patients awaiting cardiac surgery at Ottawa Hospital where minimally invasive surgery is among the offered surgical procedures.

(We now know Williams' surgery did not go as smoothly as anticipated. The operation took hours longer the originally planned because of unforeseen problems encountered in the repair of Williams' valve. His stay in the Miami hospital was about twice as long as that of many patients who have the full, traditional, sternum cutting, surgery. I am not adding this to knock the Miami hospital. I am just mentioning this to complete the story.)
A note in passing: The London Free Press, part of the Sun Media chain owned by Quebecor Media Inc., was not able to cover this important panel discussion. Why? My guess is that staffing cutbacks left the paper short staffed and unable to attend. Sad.


  1. Ken,

    The last part of your blog entry is missing. I suspect you did a copy/paste to move this story into your blog and part of the story wasn't highlighted when you did the copy part.

    I, for one, would like to know what Turnbull said about Danny Williams.


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